NAMI CA Youth Advisory Committee Interest Form

Thank you for taking interest in NAMI California's Youth Advisory Council! Please complete this form, and we will follow up with you with more information. If you are under the age of 18, please get permission from your parent/guardian before completing form.

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* 1. Please provide your name and email

First and Last Name

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* 2. If under 18, please provide a parent/guardian's name and email.

First and Last Name

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* 3. Grade

High School Freshman

High School Sophomore

High School Junior

High School Senior

Other (please specify)

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* 4. Are you a member of a NAMI On Campus High School Club?

Yes

My school has a club, but I am not a member

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* 5. County

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* 6. School District

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* 7. What days are you available from 4pm to 5pm to meet with the group?

Monday

Tuesday

Wednesday

Thursday

Friday

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* 8. Check yes to confirm that you received parent/guardian's permission to join the pilot NAMI CA Advisory Committee.

Yes